Heel-Elevation Effects on Sit-to-Stand Movement in Patients with Parkinson's Disease-A Randomized Crossover Study.

The crossover design introduced a potential carryover effect. Group B, which performed the heel-elevated tests first, showed a much smaller benefit (0.9 seconds) compared to Group A (4.3 seconds), likely because repeated testing in the elevated condition improved their performance on the subsequent flat test. The study did not measure center of gravity sway, so the proposed mechanism (anterior shift of center of gravity) remains speculative. The sample size was relatively small (n=36), and the study may have been underpowered to detect subtle differences between the specific tilt angles. The 10-minute washout period may have been insufficient to fully eliminate fatigue or learning effects between trials.

The authors declared no conflicts of interest and received no funding for the research.

Do not assume that heel elevation will produce the same magnitude of benefit for every patient. The study showed a large improvement in Group A but a negligible, non-significant improvement in Group B, suggesting that prior practice or carryover effects can mask the true benefit. Additionally, the lack of significant difference between angles does not mean any height is safe; the authors caution that height should be adjusted gradually under expert supervision.